title: Preputial reconstruction and tubularized incised plate urethroplasty in proximal hypospadias with ventral penile curvature.
abstract: OBJECTIVE
  Objective of this study was to assess the feasibility and results of preputial reconstruction and tubularized incised plate urethroplasty (TIP) in patients of proximal hypospadias with ventral penile curvature.
  
  
  METHODS
  Twenty-seven patients of proximal hypospadias who underwent preputioplasty with TIP were evaluated retrospectively. Ventral curvature was corrected by mobilization of the urethral plate with the corpus spongiosum and the proximal urethra; dorsal plication was added according to the severity of curvature. Feasibility of preputial reconstruction was assessed by applying 3 stay sutures-the first to fix the skin at the corona, the second at the junction of the inner and outer preputial skin for pulling up the skin over the glans, and the third stay on penile skin at the level of the corona for retracting the skin. Preputial reconstruction consisted of a standard 3 layered re-approximation of the margins of the dorsal hood.
  
  
  RESULTS
  Age of the patients varied from 10 months to 21 years with an average of 6 years and 4 months. Ventral curvature (mild 10, moderate 13, and severe 4 cases) was corrected by the mobilization of the urethral plate and spongiosum in 14 patients, 11 cases had mobilization of the proximal urethra in addition and 2 patients required single stitch dorsal plication with the above-mentioned steps. Two patients developed urethral fistula and 1 had preputial dehiscence.
  
  
  CONCLUSIONS
  Preputioplasty with TIP is feasible in proximal hypospadias with curvature without increasing the complication rate. Postoperative phimosis can be prevented by on-table testing of the adequacy of preputial skin by 3 stay sutures.
authors.affiliation: Department of Urology, S. P. Medical College Bikaner, Rajasthan, India.
authors.forename: Amilal
authors.initials: A
authors.lastname: Bhat
authors.forename: Ajay
authors.initials: A
authors.lastname: Gandhi
authors.forename: Gajendra
authors.initials: G
authors.lastname: Saxena
authors.forename: Gautam Ram
authors.initials: GR
authors.lastname: Choudhary